MEDICARE: AZ QUALITY NURSING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1518386465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZ QUALITY NURSING

Provider Business Mailing Address
First Line	:	2538 N 14TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1119
Country	:	US
Telephone Number	:	602-403-4817
Fax Number	:

Provider Business Practice Location Address
First Line	:	2538 N 14TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1119
Country	:	US
Telephone Number	:	602-403-4817
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. VICKIE LEE HEISLER
Credential	:
Telephone Number	:	602-403-4817

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	04/08/2014

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